Suturing is a well-known technique for reuniting the edges of a wound or incision. In many instances, the wound or incision is exposed to an extent that is sufficient to permit a surgeon to tie the suture ends into a double knot. Recent advances in surgical procedures, particularly in the area of arthroscopic surgery, have, however, presented surgeons with problems that require new approaches to suturing.
Arthroscopic surgery generally involves the use of an arthroscope for examining the interior of an injured joint, such as a knee or shoulder. The arthroscope is inserted through a small incision made in the skin. The surgeon is able to view the joint interior through the arthroscope. Surgical instruments are inserted through other small incisions. The surgeon, guided by the arthroscope, is able to perform the surgery without the need to expose the joint with a large incision.
Typically, the arthroscopic surgical procedure employs sutures for reuniting torn tissues or cartilage or for anchoring cartilage to bone. In either case, a problem associated with arthroscopic surgical techniques arises because the surgeon is unable to place his fingers inside the joint, adjacent to the sutured tissue, for the purpose of tying the suture ends into a tight double knot.
An elongated, loop-ended, instrument has been used in the past as an aid in tying suture ends into a double knot near tissue that is inaccessible to the surgeon's fingers. With this technique, the suture ends that extend outside of the incision are tied into a single knot. One of the suture ends that extends from the single knot is then threaded through the small loop formed in the end of the instrument. The instrument is passed through the incision, loop end first, while the surgeon holds the suture ends. As the loop is moved toward the tissue, the knot slides along the sutures. The knot is moved adjacent to the surface of the tissue, and the instrument is then withdrawn from the incision and slid off the suture end. A second knot is then tied in the suture ends, and the loop is used in a manner as just described to slide the second knot toward the first knot that is adjacent to the tissue. With the second knot held by the instrument near the first knot, the surgeon then tightens the suture ends to form a double knot at the tissue.
A problem with the device just described is that in the course of sliding the second knot toward the first knot, the tension on the suture ends causes the first knot to lift off the tissue so that the resultant double knot will not be formed close to the tissue. Accordingly, the suturing will be undesirably loose.